The Ins and Outs of Your First Locum Tenens Assignment
/The Ins and Outs of Your First Locum Tenens Assignment
For most doctors I talk to, there is a definite interest in locum tenens work. Most physicians have contemplated an assignment in a place they always wanted to visit or work, like California, Colorado or New York. Some describe wanting to do something different, to practice in a way that focuses on medicine over paperwork or challenge themselves in a new environment. When I ask why they don’t just do it, I often get the same response. I am told that they don’t know how to get started and that the process isn’t clear to them. Everyone knows someone who has done locums, but when pressed, most can’t break down the details of a single locum tenens assignment. Who wouldn’t sign up for anesthesia in Maui if it were easy enough? Unfortunately, inertia sets in and many doctors never take the first step into a world they would likely find both satisfaction and happiness. Well, we have some good news. Today’s blog post is going to break down the details of a doctor’s experience while on a short term locum tenens assignment. Hopefully we can shine some light on the nitty-gritty of taking a position and provide some first-hand experience to clarify the process for those considering taking the plunge. Oh, and to make it truly original, this was his FIRST locum tenens job ever!
What is your background and training?
I was born and raised in Minnesota, did my medical school and residency in Anesthesia at Vanderbilt University in Nashville, and finished in 2013. I did not do a fellowship.
When did you first start to consider locum tenens?
Well, it’s sort of complicated. I had considered locum tenens in training but honestly, none of the faculty at Vandy had any experience. There was sort of a negative stigma associated with locum tenens, and if I asked questions about it, most of the time the response I received was, “you should do a fellowship” or “aren’t you staying in academics”. I never did a fellowship and didn’t stay in academics, I ended up taking a job with a small anesthesia group that exclusively covered a hospital in West Palm Beach, Florida. The job was perfect for me, I was near my family and I was able to practice some complex cardiac cases but largely did bread and butter anesthesia with a good amount of orthopedics. Everything was fine until the health system decided to hire their own anesthesia and my group was let go. To be blunt, I was nervous as hell as to what I would do next.
How did you start to look for jobs?
At first I didn’t consider locum tenens, I looked for permanent jobs in my area. In my field there are plenty of jobs and especially in Florida. I was lucky and found a new position locally, but their start date was 4 months after my old position ended. I considered just relaxing for a little because I hadn’t taken any real time off after residency. However, I have a new house and still have medical school loans, so it wasn’t a real option for me. I looked to locums to fill the transition time. I started by just searching online for anesthesia jobs in Florida. I looked at about 10 different companies until I found one that was close to where my house is. I cant really say that there was any real structure to my search, I just spent a couple hours and stumbled upon the locums job.
Where did you find information and what questions did you ask?
Most of the information I needed came from the recruiter that I worked with through the agency. When I found the job online, I reached out to the name listed with the job. I think I left a message and he called me back about an hour later. When it came to asking questions, I’m not sure I was the one asking. Not to be funny, but the guy I worked with sort of held my hand with all the details of the process. I had never done this before and I knew it was temporary, so I wasn’t as concerned about most things. Worst case scenario, I started my knew job in a couple months so I was ok. I was really concerned with what I would be doing and what the pay was for the locums work.
Did your staffing agency offer you all the details at first?
Yeah, we talked about the job and he explained what they needed. The site I was looking at was looking for a permanent doctor but were in need of temporary coverage until they could fill the spot. From what he said, this is actually very common in my field. We talked about what was expected and the pay. He said they needed full time work, but also needed me to cover some call. When we got into the details, he explained that how busy a site is can have a large impact on how much I got paid. I never knew this about locums.
Can you tell us the details?
The job was for 3 months, Monday to Friday. Really they wanted 8 hour days and most would be 7am to 3 pm, although some days I ended up doing a later start time. They also wanted me to take one night of call a week but this was proposed to me as optional. They offered me $175 an hour to start.
Did you negotiate and did they explain to you any benefits outside pay and location?
Not really, but I didn’t know I could negotiate. The offer sounded reasonable to me when I did the math and I was in a position where it wasn’t permanent, so I figured it was good enough. Now that you bring it up, I wish I would have pressed a little to get a better deal. Going into this, I didn’t know the normal amounts an anesthesiologist was paid for locum tenens work. In regards to benefits, this wasn’t an issue at first but almost became a problem. I worked with a large agency, and they were amazing at streamlining the entire process for me. They had their own malpractice, which was seamless to set up, and they also had a travel agency that they offered to handle travel and hotel. These things weren’t a problem since I was already living close, so I didn’t really need a hotel or car. The real issue that I had to deal with was outside of the agency, it was my own health insurance. It was the first time I had to handle it outside one of my jobs and was confusing to say the least. I ended up purchasing a short-term policy and just prayed I didn’t get sick.
Once you decided on the position, how did you ensure all the details were taken care of?
I had to interview with the hospital prior to them accepting but first they requested a bunch of documentation from me. They asked for med school, residency and licensure paperwork. They also wanted peer references. It wasn’t hard to get this over to them, I had an electronic file with all of this from applying to my permanent job. I sent it all over to my staffing agent and he handled it. In the interview they reviewed my CV and asked some basic questions, but the conversation quickly turned to them recruiting me. I consider myself well trained and a normal person, so I think I should be in demand. It felt that way from the conversation with the HR people at the hospital. After the call, I spoke again to the staffing agent and he told me they want me to start right away. He handled the credentialing with the hospital and I signed a short-term contract for the position. I was able to start 2 weeks later with them.
How did you get there and where did you stay?
The position was only about 30 minutes from my home, so I didn’t need flights, hotels or a rental car. The agency did put me in touch with someone to handle this stuff but I didn’t need it. In retrospect, I wonder if not needing these things could have been used to my advantage? It was my first time, so I didn’t think to ask these questions. I was told that if I would have needed a car or hotel, they would have covered all these things for me.
How was the first day?
My first day was a bit of a whirlwind, sort of like any new job. This was the biggest concern for me with locum tenens. I am fine with not maximizing my paycheck to the fullest when it comes to a temporary position, but I really will not sacrifice when it comes to my comfort with the patient care experience. My agent was able to negotiate an onboarding day prior to my start for me to get acquainted with using the new EMR, the equipment and getting a tour. For anesthesia, knowing the setup and where everything is located is vital. I just felt better taking an extra day to learn this. It gave me the ability to find the parking lot, get my ID and shake hands with most people who work in the OR. My start date was a Friday, which tends to be light at the hospital. I covered the endo suite for GI and did colonoscopies with one of their full-time doctors. The new EMR took some time to adjust to and learning some personalities was interesting, but in general it was much smoother than I expected. I credit the onboarding day with easing the transition.
Did they pay you for the onboarding and did any issues come up while there?
Yes, they paid me for a 4 hour block of orientation. I didn’t have any issues that stand out as problematic or worth going deep into. I did think the set-up of the PACU and OR were much different than anywhere I had been before, but that’s to be expected with any new hospital. The OR moved slower than my prior job so I appreciate the extra time while I was learning. Once I was up to speed, in about a week, I felt like I could have provided more but it wasn’t asked of me.
How were you treated by the hospital admin and other doctors?
It was pretty amazing, the CEO actually came down to meet me the first day I started and everyone bent over backwards for me. I was given everything I needed from passwords, scrubs, ID, and access to the medicine and equipment I needed to succeed. The hospital staff were great and the surgeons were all receptive to me, probably because I tend to work fast. I did interact with a couple CRNAs who had been working at the hospital for years and they were all reasonable. When it came to the other staff anesthesiologists, I thought there would be some resistance or apprehension, but this may have been something from my past. You have to realize, my last positon was just taken from me by another group and I wasn’t sure if they would think I was doing the same. I quickly learned that wasn’t the case, the doctors working there were actually trying to recruit me to stay on full time! The tables were turned and I was now in demand, it felt good.
How was your last day?
Anticlimactic. I expected them to miss me and make a big deal, but when I finished my last case and charting, I said my goodbyes and left. The head of anesthesia had put a hard press on to keep me about half way through my assignment, as did the CMO, but they backed down when they learned I already had a job starting after I finished with them. They did tell me the offer stands if my new spot didn’t work out, which is a nice safety net for me. Going through the loss of a job once, I don’t ever want to deal with it again. Knowing locums offers the ability to transition takes a lot of anxiety away, especially now since I am familiar with the process.
How did the process of getting paid work?
I kept a timesheet of my hours worked. I submitted this to the hospital every 2 weeks. The hospital signed off and submitted it to the locums agency. I was paid the next day. Of all the things I was worried about, this turned out to be the most efficient part of the entire process. It was straight forward, and I had no issues getting paid what was owed and fast.
What’s next for you?
Well, I started at my new position a couple of weeks ago. It’s going well and I am pretty happy. Nothing is perfect but I can’t complain.
Would you recommend locum tenens to a colleague?
I would, and I think my eyes are now open to how locums can be used for many different reasons. Knowing that locums can be a full-time career move or even for a couple years made sense but utilizing short term locums to fill in for various reasons has become a new option for me. I was more than happy and would totally recommend it to other doctors. For me it bridged the gap, but I could see using it to make some extra money to pay off my med school loans or try out an area before I took a job there. After doing it once, I’m surprised more don’t use it.
That marked the end of our interview, but we had some big questions that we now need to address in future posts. Namely, what is the best way to handle health Insurance and how do you handle other doctors who question your intentions or credentials while on assignment? These items matter and we plan on getting you answers!
~The Locums Life~
FAQ: Preparing for Your First Locum Tenens Assignment as a Physician
1) What should I do first when preparing for my first locum tenens assignment?
Start with clarity and structure. Your first locum tenens assignment is not just “a job”—it’s a mini business launch. Before you say yes, clarify:
your goals (income, flexibility, travel, lifestyle)
the exact clinical scope (clinic, inpatient, OR, call)
your must-haves (schedule, pay, location, housing standards)
If you skip this step, you’ll end up choosing an assignment that pays well but feels miserable.
2) How far in advance should I start preparing for a first locums assignment?
Earlier than you think. Credentialing, licensing, and hospital onboarding are the long poles in the tent. Many physicians begin planning 2–4 months ahead (sometimes longer for certain states or facilities). If you want a specific location or start date, start the process early.
3) What’s the biggest “rookie mistake” on a first locum tenens assignment?
Assuming everything will be handled for you. Yes, agencies help. But you’re still responsible for:
knowing your contract terms
confirming malpractice coverage type and tail
understanding pay schedule
keeping tax records
ensuring the clinical scope matches your skill set
arriving prepared for the hospital workflow
A great recruiter is helpful; a prepared physician is unstoppable.
4) What documents do I need for credentialing and onboarding?
Expect to provide (some variation of):
current CV with precise work history
medical license(s)
DEA registration
board certification/eligibility
NPI number
BLS/ACLS (and others if relevant)
immunizations and titers (TB, Hep B, MMR, Varicella, etc.)
malpractice claims history (if any)
references (often 2–3)
diploma/residency verification
case logs (procedural specialties)
background check and drug screen
Make a digital folder now—credentialing becomes easy when you’re organized.
5) Should I get multiple state licenses before my first assignment?
Not necessarily, but it can help. If you already know the region you want, pursue that state license early. For physicians who plan to do locums long-term, building a “license portfolio” can increase opportunity and reduce downtime between assignments.
6) How do I choose the right first locum tenens assignment?
Choose your first assignment for success, not just pay. The ideal first assignment is:
well-supported facility (good staff, clear processes)
predictable schedule
reasonable volume
scope you can perform confidently
decent housing and short commute
straightforward credentialing
Once you’ve done 1–2 successful assignments, you can start optimizing for adventure, pay, or unusual practice settings.
7) What questions should I ask a recruiter before accepting my first assignment?
Ask these and get answers in writing:
What is the clinical setting (clinic/inpatient/OR/ED)?
What is the schedule and call burden?
What is average patient volume?
Is there APP/resident support?
What EMR is used and what training is provided?
What is the pay rate and what counts as billable time?
How are overtime and call paid?
What expenses are covered (travel, lodging, car, meals)?
How does cancellation/termination work?
What malpractice policy is provided (occurrence vs claims-made + tail)?
How and when do I get paid?
If a recruiter can’t answer, it’s either a red flag—or they haven’t done the homework.
8) How do I negotiate my first locum tenens contract without feeling uncomfortable?
Keep it professional and simple:
Define your rate based on scope + call + urgency
Ask for clarity on cancellation and guaranteed hours
Confirm malpractice details (especially tail)
Confirm travel/lodging standards
Ask for a short initial term if you’re unsure (1–2 weeks trial)
Negotiation isn’t confrontation. It’s defining expectations.
9) Should I have a lawyer review my first locums contract?
It’s often worth it at least once, especially if:
the contract has restrictive non-competes
cancellation penalties are unclear
malpractice language is vague
the assignment is long-term or high-risk
your specialty has higher liability exposure
Even one review can teach you what to look for in every future contract.
10) What should I know about malpractice insurance before my first shift?
Confirm:
policy type (occurrence vs claims-made)
limits (often $1M/$3M or facility-required)
whether tail is included if claims-made
that you are named/covered
dates and locations match your assignment
scope matches duties (procedures, supervision, call)
This is not optional. Never assume “covered” means “protected.”
11) How do I prepare financially for my first locums assignment?
Remember: your first checks may be large, but taxes are not withheld. Start a simple system immediately:
Separate checking account for locums income
Automatically move a percentage (often 30–40% as a rough start) to a tax bucket
Consider quarterly estimated taxes
Track expenses and reimbursements
Plan for delayed pay (some agencies pay net 14–30)
Cash flow management is the difference between “locums freedom” and “locums stress.”
12) Do I need an LLC for my first locum tenens assignment?
Not necessarily. Many physicians start as a sole proprietor and add structure later. An LLC can help with organization and professionalism, but it’s not required to begin working locums. If you plan to do locums consistently, it may be worth discussing entity structure with a CPA.
13) What about health insurance and disability insurance?
If you’re leaving a W-2 job, benefits can change overnight. Before your first assignment:
confirm health insurance coverage (spouse plan, ACA plan, agency plan, COBRA bridge)
strongly consider own-occupation disability insurance (your income is your asset)
consider term life insurance if you have dependents
Locums is flexible—but your insurance must be stable.
14) What travel and housing arrangements should I confirm?
Confirm:
hotel vs furnished housing vs stipend
distance to hospital
parking and safety
cancellation risk (who absorbs costs if assignment ends early)
whether you can collect hotel points
If housing is bad, the assignment feels twice as hard.
15) What should I pack for my first locum tenens assignment?
Bring:
professional documents (license, DEA, copies of credentials)
required clinical gear (stethoscope, headlamp, loupes if needed)
scrubs/white coat as required
laptop/tablet for EMR access (if allowed)
comfort kit for sleep (earplugs, eye mask, white noise)
personal essentials (meds, chargers, power strip)
a small “kitchen kit” if extended stay (knife, spices, protein staples)
You’re building a temporary life base—pack for performance.
16) How do I prepare clinically for a new facility?
Before day one:
ask for orientation schedule
learn the EMR name and watch basic tutorials (if available)
clarify admission/discharge workflow
understand consult process, escalation, and call coverage
know where supplies, forms, and key phone numbers live
Your first few shifts should be about safe care—not searching for passwords.
17) What should I do on the first day at the hospital?
Your goal is to build a “workflow map.” Focus on:
meeting charge nurse/unit leadership
learning the paging system and who to call for what
confirming rounding structure and documentation requirements
identifying where to find policies/order sets
understanding how consults work and who is backup
Be friendly, humble, and proactive. It pays dividends immediately.
18) How do I build trust quickly as the “new locums doc”?
Three behaviors build trust fast:
show up early and prepared
communicate clearly and respectfully
ask questions before problems occur
Staff will forgive you for not knowing the system; they won’t forgive arrogance or chaos.
19) What if the assignment is different than advertised?
It happens. If scope creep appears (extra call, extra procedures, extra locations):
document what changed
talk to your recruiter immediately
ask for contract clarification or compensation adjustment
if needed, invoke termination/cancellation terms
Don’t absorb silent risk. Handle it professionally and early.
20) How do I handle timesheets and getting paid correctly?
Treat it like a system:
submit timesheets on schedule
keep your own log of hours/call/extra shifts
confirm who approves timesheets
reconcile pay stubs against your log
save everything in a folder
Most pay problems are “process problems,” not malice.
21) What should I do after my first week to improve the rest of the assignment?
Do a quick debrief:
what’s working in workflow?
what’s slowing you down?
what do you need clarified?
do you need schedule changes?
is housing acceptable?
Make small adjustments early and the assignment becomes dramatically easier.
22) What is the best way to extend or repeat assignments?
If it’s a good fit:
discuss extension early (4–6 weeks before end for longer gigs)
renegotiate if scope increased
ask for improvements (better housing, better schedule blocks)
keep your credentialing file updated for faster repeats
Repeat assignments are where locums becomes efficient and enjoyable.
23) How do I avoid burnout on my first locum tenens assignment?
Don’t overwork. Many physicians feel pressure to “prove themselves” and say yes to everything. Instead:
protect sleep
limit excessive call
take recovery days seriously
keep exercise and nutrition simple
maintain connection with family/friends
Locums is a marathon of assignments, not one heroic month.
24) What’s the bottom line for preparing for your first locum tenens assignment?
Here’s a clean closing paragraph you can add to your blog:
“Preparing for your first locum tenens assignment as a physician requires more than choosing a location and rate. The most successful locum tenens doctors plan credentialing early, confirm malpractice insurance and contract terms in writing, create a simple tax and payment tracking system, and arrive ready to learn the facility workflow. A smooth first assignment sets the foundation for a flexible, high-income locum tenens career.”
Disclaimer
This FAQ is educational and not legal, tax, or financial advice. Always confirm contract and insurance details with professionals as needed.